monica bharel md, mph commissioner of public health ... · 3/22/2019 · january 2015. powerpoint...

Commonwealth of Massachusetts

Monica Bharel MD, MPH Commissioner of Public Health

January 12, 2017

Draft for Policy ng Purposes Only

Massachusetts DPH by the numbers

History dates back to 1799

8 Bureaus

6 Offices

More than 15 sites in

Massachusetts

~$1 billion budget

~3000 Employees

The Range of DPH

Prevention and Wellness – Health Access – Nutrition – Perinatal and Early Childhood – Adult Treatment – Data Analytics and Support – Housing and

Homelessness – Violence and Injury Prevention – Office of Statistics and Evaluation – Childhood Lead Poisoning Prevention – Community Sanitation – Drug Control – Occupational Health Surveillance – PWTF – SANE Program – Interagency Initiatives – Planning and Development – Prevention – Problem Gaming – Quality Assurance and Licensing – Youth and Young Adults – Early

Intervention – Children and Youth with Special Needs – Epidemiology Program – Immunization Program – Global Populations and Infectious Disease Prevention – STI Prevention – HIV/AIDS – Integrated Surveillance and Informatics Services – Clinical Microbiology Lab – Chemical Threat, Environment and Chemistry Lab – Childhood Lead Screening – Environmental

Microbiology and Molecular Foodborne Lab – STD/HIV Laboratories – Biological Threat Response Lab – Central Services and Informatics – Quality Assurance – Safety and Training – Health Care Certification and Licensure – Health Professional Licensure – Office of Emergency Medical Services – DoN – Medical Use of Marijuana – Shattuck Hospital – Mass Hospital School –

Tewksbury Hospital – Western MA Hospital – State Office of Pharmacy Services – Office of Local and Regional Health – Office of Health Equity – Accreditation and Performance Management – ODMOA – OPEM – HR and Diversity – Office of General Counsel – Office of CFO – Commissioner’s Office

Massachusetts Department of Public Health

Massachusetts DPH will be a national leader

in innovative, outcomes-focused public health

based on a data-driven approach, with a

focus on quality public health and

health care services and an

emphasis on the social determinants

and eradication of health disparities.

VISION Optimal health and well-being for all people in

Massachusetts, supported by a strong public health infrastructure and healthcare delivery.

MISSION

The mission of the Massachusetts Department of Public Health (DPH) is to prevent illness, injury, and premature death; to ensure access to high quality public health and health care services; and to promote wellness and health

equity for all people in the Commonwealth.

DISPARITIES

We consistently recognize and strive to eliminate health

disparities amongst populations in Massachusetts,

wherever they may exist.

DETERMINANTS

We focus on the social determinants of health - the conditions in which people

are born, grow, live, work and age, which contribute to

health inequities.

DATA We provide relevant, timely

access to data for DPH, researchers, press and the

general public in an effective manner in order to target

disparities and impact outcomes.

INCLUSIVENESS AND COLLABORATION

EVERYDAY EXCELLENCE

PASSION AND INNOVATION

Social Determinants of Health

Social determinants of health refer to conditions of society that reflect root causes of community and individual health and well-being.

• There may be significant differences in the distribution of these social and environmental resources, with a significant association between these resources and health outcomes.

• These determinants drive health inequities

Advancing Community Public Health Systems in the 21st

Century. National Association of County and City Health

Officials, 2001.

Individual resources

Education, occupation, income, wealth

Neighborhood resources

Housing, food choices, public safety, transportation, parks and recreation, political clout

Hazards and toxic exposures

Pesticides, lead, reservoirs of infection

Opportunity structures

Schools, jobs, justice

Determinants of Health

CDC: Social Determinants of Health and Social Determinants of Equity, the Impacts of Racism on the Health of our Nation

Social determinants

of health (contexts)

Individual

behaviors

CDC’s Health Impact Pyramid AJPH April 2010

Counseling and

education

Clinical interventions

Long-lasting protective interventions

Changing the context to make individuals’ default decisions healthy

Socioeconomic factors

Largest impact

Smallest impact

Eat healthy, be physically active

Rx for high blood pressure,

high cholesterol, diabetes

Immunizations, brief

interventions

Fluoridation, no trans fat,

smoke-free laws

Poverty, education, housing,

inequality

Total Annual Expenditures by Expenditure Group for BHCHP Users

with Medicaid in 2010 A JPH 2012

25%

1.4%

25%

6.5%

25%

18.6%

15%

25.5%

10%

48.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Users (N=6,493) Expenditures ($149 million)

90 – 100% (650 users)

75 – 90% (974 users)

50 – 75% (1,623 users)

The gap in life expectancy between the richest 1% & poorest 1% of

individuals: 14.6 years

JAMA online April 10, 2016

U.S. Infant Mortality

Rate 2011

CDC Vital Statistics

Infant Mortality Rates in Massachusetts’ Largest Cities 2012

The opioid epidemic burden in Massachusetts

74% OF OPIOID DEATHS IN 2016 HAD THE PRESENCE OF FENTANYL

The opioid epidemic burden in Massachusetts

The rate of NAS is increasing significantly in Massachusetts

Sources:

1. Gupta M and Picarillo A. Neonatal abstinence syndrome (NAS): improvement efforts in Massachusetts. neoQIC. January 2015. PowerPoint presentation.

2. Patrick S, Davis M, Lehman C, Cooper W. Increasing incidence and geographic distribution of neonatal abstinence syndrome: Unites States 2009 to 2012. Journal of

Perinatology 2015; doi: 10.1038/jp.2015.36. [Epub ahead of print]

From 2004 to 2013 the Incidence of NAS increased from <3/1000 hospital births to >16/1000 hospital births per year

National average

3.4

5.8

MA rate of NAS was

triple the national average in 2009

Prevention Intervention Treatment Recovery

Governor Baker’s Opioid Working Group

Survey: reason for prescription painkiller misuse

Too easy to get painkillers from those whosave pills

Painkillers are prescribed too often or indoses that are bigger than necessary

Too easy to buy prescription painkillersillegally

47%

50%

58%

Source: Boston Globe and Harvard T.H. Chan School of Public Health, Prescription Painkiller Abuse: Attitudes among Adults in

Massachusetts and the United States

Preventing Prescription Drug Misuse: Screening, Evaluation, and Prevention

1. Evaluate a patient’s pain using age, gender, and culturally appropriate evidence-based methodologies.

2. Evaluate a patient’s risk for substance use disorders by utilizing age, gender, and culturally

appropriate evidence-based communication skills and assessment methodologies, supplemented with relevant available patient information, including but not limited to health records, family history, prescription dispensing records (e.g. the Prescription Drug Monitoring Program or “PMP”), drug urine screenings, and screenings for commonly co-occurring psychiatric disorders (especially depression, anxiety disorders, and PTSD).

3. Identify and describe potential pharmacological and non-pharmacological treatment

options including opioid and non-opioid pharmacological treatments for acute and chronic pain management, along with patient communication and education regarding the risks and benefits associated with each of these available treatment options.

Medical Core Competencies: Primary Prevention Domain

MassPAT: The new PMP

Reversing an Overdose: Use of Naloxone

Adding hundreds of new treatment beds across the state; Beginning the transfer of women civilly committed under Section 35

at MCI Framingham to Taunton State Hospital; Reinforcing the requirement that all DPH licensed addiction

treatment programs must accept patients who are on methadone or buprenorphine medication;

Strengthening the state’s commitment to residential recovery programs through rate increases.

Issuance of Division of Insurance guidelines to commercial insurers on the implementation of the substance use disorder recovery law (Chapter 258) which requires insurers to cover the cost of medically necessary clinical stabilization services for up to 14 days without prior authorization;

Treatment and Recovery: General Progress To-Date

Substance Use, Treatment, Education and Prevention Law (STEP)

Ch. 52 of the Acts of 2016

• 7 day limit on a first time opioid prescription; allows for a

pharmacist partial fill • Patient voluntary non-opioid directive (12/16) • SBIRT must be implemented in schools by June 2018 • Amends the Civil Liberties law so that any person who

administers naloxone is not liable for injuries resulting from the injection

• Requires substance abuse evaluation in ED when present for an OD (7/16)

Chapter 55 – Data mapping

PDMP

APCD Spine

Death Records

BSAS Treatment

Toxicology

Summarized APCD

MATRIS (ambulance)

OCME Intake

Town/Zip Level Data

Summarized Casemix

Dept of Corrections

MA Sheriff’s Association

System Attributes

• Data encrypted in transit & at rest

• Limited data sets unlinked at rest

• Simplified structure using summarized data

• Linking and analytics “on the fly”

• No residual files after query completed

• Analysts can’t see data • Automatic cell suppression • Possible resolution to issues

related to 42 CFR part 2

Data Sources

DPH

CHIA (MassHealth)

EOPSS

Jails & Prisons

All Doors Opening

• Significant coordination within DPH

• Financial and technical support from MassIT’s Data Office

• CHIA takes on role as linking agent

• Coordination across agencies (legal & evaluation)

• Volunteer analytic support from academia and industry

Chapter 55 Data Structure

Births (NAS)

DRAFT - FOR POLICY DEVELOPMENT ONLY

* Note: Houses of Correction data was

unavailable at the time this report was

written. As such, assessment does not

reflect HOC inmate outcomes.

*

31


32

Chapter 55: Key Finding

Patients treated with methadone and/or buprenorphine (Opioid Agonist Treatment or “OAT” that block the effect of opioids) following a non-fatal overdose were significantly less likely to die; however, very few patients (~5%) engage in OAT following a non-fatal overdose.

0

0.5

1

1.5

2

2.5

Engaged in OAT Not Engaged in OAT

Cu

mu

lati

ve In

cid

en

ce (

%)

Figure 2: Cumulative Incidence of Opioid-Related Death by OAT Status


33

Chapter 55: Key Finding

The risk of opioid overdose death following incarceration is 56 times higher than for the general public.

869.4 opioid deaths / 100,000

15.4 opioid deaths/ 100,000

0

100

200

300

400

500

600

700

800

900

1000

Former Inmates All Others

Comparison of Opioid Death Rates Among Former Inmates to the Rest of State (2013 - 2014)

Monica Bharel, MD, MPH Commissioner of Public Health

monica bharel md, mph commissioner of public health ... · 3/22/2019 · january 2015. powerpoint...

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